1245469303 NPI number — PAULA LOCKE, LCSW, CAP, PA

Table of content: (NPI 1245469303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245469303 NPI number — PAULA LOCKE, LCSW, CAP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAULA LOCKE, LCSW, CAP, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TOTAL INTERVENTION EARLY SERVICES (TIES)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245469303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9470 LIVE OAK PL
Provider Second Line Business Mailing Address:
SUITE 405
Provider Business Mailing Address City Name:
DAVIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-4769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
754-204-0312
Provider Business Mailing Address Fax Number:
954-302-1830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4699 N STATE ROAD 7
Provider Second Line Business Practice Location Address:
SUITE P
Provider Business Practice Location Address City Name:
LAUDERDALE LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33319-5879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-234-2724
Provider Business Practice Location Address Fax Number:
954-302-1830
Provider Enumeration Date:
07/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKE
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
LICENSE CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
754-204-0312

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171M00000X , with the licence number: 761451900 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 172V00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001314200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 761451900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002968700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001867700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DJ386A . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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